Invoice Physiotherapist in India Mumbai –Free Word Template Download with AI

Dr. Ananya Deshmukh, MPT (Ortho)

Reg. No: MH-PT-2018-4592

Shop No. 4, Linking Road, Bandra West,

Mumbai, Maharashtra, India - 400050

GSTIN: 27AADFM1234G1Z5

Email: [email protected] | Phone: +91 22 2645 8899

Invoice No: INV-MUM-2023-0892

Date: October 24, 2023

Due Date: November 07, 2023

Bill To (Patient Details)

Mr. Rohan Mehta

Flat 12-B, Sea View Apartments,

Worli, Mumbai, Maharashtra, India - 400018

PAN: ABCPM1234D

Mobile: +91 98765 43210

Treatment Period

Start Date: October 10, 2023

End Date: October 23, 2023

Diagnosis Code (ICD-10): M54.5 (Low Back Pain)

Referring Physician: Dr. S. K. Iyer (Orthopedic)

Description of Physiotherapy Services Rendered

#	Service Description	Qty	Rate (INR)	Amount (INR)	HSN/SAC
1	Initial Comprehensive Physiotherapy Assessment & Postural Analysis	1	2,500.00	2,500.00	999411
2	Manual Therapy & Soft Tissue Mobilization (15 Sessions)	15	1,200.00	18,000.00	999411
3	Therapeutic Ultrasound & IFT (Interferential Therapy)	10	800.00	8,000.00	999411
4	Core Strengthening & Stabilization Exercises (Supervised)	15	1,000.00	15,000.00	999411
5	Home Exercise Program (HEP) Prescription & Follow-up	1	1,500.00	1,500.00	999411

Subtotal: ₹ 45,000.00 Discount (Senior Citizen/Insurance): - ₹ 0.00 GST (18% on Healthcare Services): ₹ 8,100.00 TOTAL PAYABLE: ₹ 53,100.00

Amount in words: Indian Rupees Fifty-Three Thousand One Hundred Only.

Payment Instructions

Please make the payment within 15 days of the invoice date. Late payments may incur a penalty of 2% per month.

Bank Transfer Details:

UPI ID: msmphysio@hdfcbank

Terms and Conditions

This invoice is computer-generated and valid without a physical signature.
Services rendered are based on the clinical assessment conducted by the registered Physiotherapist in Mumbai.
Payment is due within 15 days from the date of this invoice.
Any disputes regarding the charges must be raised within 7 days of receiving this invoice.
Refunds are subject to the clinic's cancellation policy and prior notice.
GST is applicable as per the Government of India regulations for healthcare services.
Please quote the Invoice Number (INV-MUM-2023-0892) while making the payment.

Authorized Signatory

For Mumbai Spine & Motion Physiotherapy

Received By (Patient)

Date: _______________

Thank you for choosing our physiotherapy services in Mumbai, India. We wish you a speedy recovery.

This document serves as a financial record for tax and insurance purposes.

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